Wk1: Please post answers to the following to the forum before the start of class on January 16th:
1. Write a paragraph describing the extent to which an socioecological framework incorporating issues related to social determinants has been applied to your area of research. Are there opportunities for improving our understanding of or approach to disparities in your area with a greater emphasis on a socioecological framework?
My current research involves understanding patient preferences and experiences pertaining to family planning. A socioecological framework related to social determinants of health has been applied in my area of research by examining various social, cultural, economic and other social determinants of health and the influence of these factors on a patient's family planning experience. For example, a recent study assessed whether disparities in contraceptive counseling exist by patient race/ethnicity and socioeconomic status (for most measures, there were no differences by patient race/ethnicity and highest level of parental education achieved) (Dehlendorf et al., 2017). Other studies have examined disparities in patient experience of counseling by race/ethnicity and have found that Black women are more likely to report being pressured to use a contraceptive method and Latina women are more likely to report experiencing less patient-centered care (Becker and Tsui, 2008, Downing et al., 2007)
There are many opportunities for improving our understanding of disparities in my area with a greater emphasis on a socioecological framework. For example, more studies examining gender and sexual minorities and their experiences with family planning experiences.
2. In the WHO reading, A conceptual framework for action on the structural determinants of health, the authors describe structural stratifiers (e.g. income, education, etc) and intermediary determinants such as material and psychosocial circumstances. Pick 3 of these factors (at least one structural and one intermediary). Explain why you chose the factors (might use Braveman article to provide justification) and describe how each could be an important determinant of a health outcome of your choosing. The association could be reported in published research or it could be your hypothesized relationship. Consider whether how these factors might function over the lifecourse and/or intergenerationally.
Education: Education has been linked to several health outcomes. Having a lower level of education has been shown to be associated with increased risk for unintended pregnancies (Dehlendorf et al, 2010) and therefore it can be assumed that education is a determinant of health for patient experiences pertaining to family planning. For example, if a provider fails to consider a patient's education level and, along the same vein, health literacy level, he or she could be doing a great disservice to the patient with regard to the quality of contraceptive counseling a patient receives by either under or over shooting the support the patient needs to make a decision regarding contraception. This factor could function over the lifecourse and perhaps even intergenerationally depending on the outcome of the experience.
Race/Ethnicity: Race/ethnicity is a well-documented and important determinant of health for patient experiences pertaining to family planning. For example, a study comparing client preferences of different racial/ethnic groups, English- and Spanish-speaking Latina participants were more likely than White or Black participants to value continuity of care with their family planning provider (Becker and Tsui, 2008). This could impact a patient's family planning experience across her life course in several ways. One example would be a patient who has a negative contraceptive counseling experience in her teens and is then less comfortable seeking out reproductive health services later in life.
Income:Income is another important and well-documented in the literature determinant of health for patient experiences pertaining to family planning. Income’s influence on family planning experiences traverse many aspects of care, one of which is service attainment. For example, a patient who’s income precludes her from affording transportation to a clinic with family planning services will not even have the opportunity to engage in a conversation regarding her reproductive health goals. Such circumstances have the potential to impact a patient’s family planning experience across her life course.